Unraveling Nonadherence in Nonmuscle Invasive Bladder Cancer Follow-up in South Indian Population: Factors, Consequences, and Strategies for Improvement

Abstract

Purpose: This study investigated treatment adherence patterns and associated factors in patients diagnosed with nonmuscle invasive bladder cancer (NMIBC). Methods: In a prospective study from 2021 to 2023, we enrolled NMIBC patients undergoing surveillance and those seeking bacillus Calmette–Guérin (BCG) instillations. Patients were categorized based on tumor grade and risk stratification. A detailed questionnaire assessed patient demographics and factors affecting treatment adherence, spanning socioeconomic, clinical, psychological, and treatment-related aspects. Treatment adherence was classified as complete, partial, or nonadherence. Statistical analysis determined factors influencing adherence. Results: The study included 76 NMIBC patients, primarily in the intermediate/high-risk category (72.4%). Among them, 44.8% were nonadherent, 35.5% fully adhered at 6 months, and 19.7% partially adhered. Significant factors affecting adherence included lack of procedure/schedule explanation by the doctor (P < 0.001, most significant), BCG side effects (P = 0.018, more side effects correlated with follow-up loss), and travel mode (P = 0.045, higher nonadherence with public transport). Variables that might be clinically significant were gender (P = 0.070), European Association of Urology Risk (P = 0.060), and attender availability (P = 0.061). In low-risk patients, expenditure per visit (P = 0.003) and lack of explanation by the doctor (P < 0.001) were significant. In intermediate/high-risk patients, travel mode (P = 0.038) and lack of explanation (P < 0.001) were significant factors. Conclusions: Our findings reveal a high prevalence of nonadherence to NMIBC follow-up protocols. Inadequate physician explanation about the importance of follow-up after transurethral resection of bladder tumor emerged as the primary cause of nonadherence. Economic constraints and BCG side effects also impacted adherence. These results underscore the need for tailored interventions, focusing on enhanced patient education, communication, and economic support.